By Rustina, Contributing Writers
Growing your family is a delicate choice. You want to know that you are ready for whatever choice you make. That requires a lot of care and hard choices – very personal choices.
We aren’t here to judge anyone or tell you what to choose. We do, however, think it is important to be well informed of the choices AND the risks.
Why It Matters What You Choose
So many people in today’s society are struggling with hormone imbalance that affects their quality of life. Many, myself included, struggle in part because of the choices they made in birth control. Anytime that we add artificial or outside hormones to our body, we alter our own hormones.
Hormones have very important jobs throughout our body. They deliver messages from our brain to organs, muscles, nerves, and other tissues telling our body when and how to do functions. Everything from wanting to eat to being able to fall asleep is dictated by our hormones!
Here are some signs of a hormonal imbalance (1):
- Weight gain/inability to lose weight (especially around the midsection)
- Fatigue/Poor quality sleep/troubles falling asleep
- Anxiety/depression
- Headaches
- Acne
- Frequently feeling cold, especially in extremities
- Brain fog/Impaired memory
- Hair loss/Unwanted hair growth
- Irregular periods or painful periods
- Hard to control appetite
- Low or absent sex drive
- Infertility
It is not easy dealing with or correcting hormone balance. It takes time and commitment to balance them, but it can be done! Don’t lose hope. Learn more about what else influences hormones and ways to restore the balance of your hormones in 7 Ways to Naturally Balance Your Hormones.
Unfortunately, all those potential side effects are not the end of the story. Some women develop conditions that cause further pain and discomfort in life, like autoimmune conditions, diabetes, hypothyroidism, deep vein thrombosis, heart attacks, strokes, and polycystic ovary syndrome (PCOS).
There are many methods of birth control, many associated with these conditions, so understanding their benefits versus their risks is important for informed consent.
Methods of Birth Control
There are many different options, but it mostly comes down to choosing between hormone altering methods and ones that are not as effective but have less risks of disrupting the hormone balance.
The below information covers effectiveness, costs, and how it works (2,3). It also has notes and some of the risks and effects from each method.
Hormonal Options
All of the hormone options are at risk of disrupting your hormone balance and leading to the above mentioned concerns.
Birth Control Implant
- Effectiveness: 99%
- Cost: up to $1300
- Length of coverage: up to 3 years.
- How it works and other notes: This injects an implant and has 3 mechanisms to it.
- First: It releases a synthetic version of progesterone to prevent the release of an egg.
- Second: It thickens the mucus plug to reduce the likelihood of sperm entering the womb.
- Third: It thins the lining of the uterus so that if an egg is released and fertilized, it is unlikely to be able to implant, thus aborting the pregnancy.
- Some of the risks and side effects:
- Bone density loss (the increase in progesterone causes a decrease in estrogen and sex hormone–binding globulin (SHBG) – estrogen’s transporter that also affects testosterone levels and when low, is associated with weight gain, metabolic dysfunctions, cardiovascular health concerns, ovarian cysts, cancer, arthritis, liver disease, and venous thrombosis (4).
- Implant migration can occur causing it to block an artery (5)
- Low estrogen (like what is seen in menopause) results in lowered function of osteocytes which control bone structure, growth, and maintenance. This ends up meaning less calcium throughout your body – usually in your bones, although these cells can affect more than just the much easier to define and recognize bone loss.
- Pain in the back or stomach area.
- Ovarian cysts
- Lower sex drive
- Dizziness
- Headaches
- Insulin resistance
- Mood swings and depression
Birth Control Shot (Depo-Provera)
- Effectiveness: 96%
- Cost: $0 to $150
- Length of coverage: 3 months (limit of 2 years except in extreme cases due to risks)
- How it works and other notes: This injection has 3 mechanisms to it.
- First: It releases a synthetic version of progesterone to prevent the release of an egg.
- Second: It thickens the mucus plug to reduce the likelihood of sperm entering the womb.
- Third: It thins the lining of the uterus so that if an egg is released and fertilized, it is unlikely to be able to implant, thus aborting the pregnancy.
- Notes: Many women will not have a period at all during their use of the shot. However, in some rare cases, women will bleed for many days during the shot or after they stop (I bled heavily for over 20 days after discontinuing). Some may not get their periods back for up to 10 months or their fertility for 12-18 months.
- Some of the risks and side effects:
- Bone density loss (the increase in progesterone causes a decrease in estrogen and sex hormone–binding globulin (SHBG) – estrogen’s transporter that also affects testosterone levels and when low, is associated with weight gain, metabolic dysfunctions, cardiovascular health concerns, polycystic ovarian syndrome, cancer, arthritis, liver disease, blood clots, and venous thrombosis (6)(7).
- Low estrogen (like what is seen in menopause) results in lowered function of osteocytes which control bone structure, growth, and maintenance. This ends up meaning less calcium throughout your body – usually in your bones, although these cells can affect more than the much easier to define and recognize bone loss.
- Pain in the back or stomach area.
- Lower sex drive
- Dizziness
- Headaches
- Insulin resistance
- Mood swings and depression
IUS (intrauterine system)
- Effectiveness: 99%
- Cost: up to $1300
- Length of coverage: Lasts Up To 3-12 years
- How it works and other notes: This T shaped device is like the IUD, but combines the use of hormones. IUS releases a low dose of hormone into the womb. This thickens the cervix mucous lining to reduce the chance of the sperm reaching the egg. It also alters the lining of the womb to prevent the egg from implanting (meaning even a fertilized egg may be spontaneously aborted). There are 5 distinct factors that are clues to avoid a copper IUD: frequent infection, being pregnant, uterine conditions, gynecologic cancer, and adverse reactions to copper (8).
- Some of the risks and side effects:
- Periods may become longer and heavier with more cramps/pain.
- Increased risk of infections (yeast and bacterial vaginosis) – especially with longer periods.
- Although considered rare, it can damage the uterine wall even causing a hole.
- If hormone based, then added hormone imbalance concerns (including moods, weight gain, headaches, etc).
- Increased risk of ectopic pregnancy (egg is implanted outside of the womb, usually in the fallopian tubes where the egg will not be able to grow or be saved. These pregnancies are also dangerous for the mother.
Birth Control Pill
- Effectiveness: 93%
- Cost: $0 to $50
- Length of coverage: Take daily
- How it works and other notes:
- The released hormones prevent egg development/release, thicken cervical mucus lining, and disrupt the uterus lining so if a fertilized egg does make it the chances of implantation are low.
- The pills deliver estrogen and progestin (like the rings and patches). It is available in different strengths.
- There is one without estrogen called the Minipill. This one has a greater risk of ectopic pregnancy because it isn’t as effective at preventing ovulation.
- Some of the risks and side effects:
- Legs (deep vein thrombosis)
- Lungs (pulmonary embolus)
- Eyes (loss of eyesight)
- Heart (heart attack)
- Brain (stroke)
- Nausea
- Breast tenderness or enlargement
- Headaches (may be clot related so if headaches develop – consider changing birth control and contact your health care provider)
- Missed periods
- Weight gain/fluid retention especially around the breasts and hips
- Mood changes
- Decreased sex drive (from the increase in estrogen and progestin)
- Vaginal discharge changes
- High blood pressure
- Liver tumors and gallstones
- Cancer risks: Breast and Cervical
- Blood clots
- The warning signs of a blood clot spell out the word ACHES (9):
- Abdominal pain
- Chest pain (also shortness of breath)
- Headaches (especially those that are new, severe, or associated with persistent dizziness, difficulty speaking, fainting, numbness or weakness in extremities
- Eye problems (blurred vision or loss of vision)
- Severe leg pain (and/or redness and swelling in the calf or thigh)
Birth Control Vaginal Ring
- Effectiveness: 93%
- Cost: $0 to $200
- Length of coverage: Put in and take out every certain number of weeks for your period. Nuvaring is disposable and Annovera is reusable for up to a year.
- How it works and other notes: The rings are similar to other hormonal methods, it releases hormones that prevent egg development/release, thicken cervical mucus lining, and disrupt the uterus lining so if a fertilized egg does make it the chances of implantation are low. The hormones released are estrogen and progestin, like the birth control patch and pills (although there is a variety available).
- Some of the risks and side effects:
- Legs (deep vein thrombosis)
- Lungs (pulmonary embolus)
- Eyes (loss of eyesight)
- Heart (heart attack)
- Brain (stroke)
- It may be uncomfortable for some
- Cause irritation or infections
- May be easy to forget and leave in too long causing worse infections and hormone disruption as well as more serious issues
- Headaches (may be clot related so if headaches develop – consider changing birth control and contact your health care provider)
- Missed periods
- Mood changes
- Decreased sex drive (from the increase in estrogen and progestin)
- Vaginal discharge changes
- Cancer risks: Breast
- Blood clots
Birth Control Patch
- Effectiveness: 93%
- Cost: $0 to $150
- Length of coverage: Replace weekly
- How it works and other notes: Once a week for three weeks in a row, you place the small patch on your skin (belly, butt, or upper arm), wearing a patch for a total of 21 days. The patches deliver estrogen and progestin (like the rings and pills). It is available in different strengths. The released hormones prevent egg development/release, thicken cervical mucus lining, and disrupt the uterus lining so if a fertilized egg does make it the chances of implantation are low.
- Some of the risks and side effects:
- Legs (deep vein thrombosis)
- Lungs (pulmonary embolus)
- Eyes (loss of eyesight)
- Heart (heart attack)
- Brain (stroke)
- Cause irritation
- May be easy to forget and leave on too long
- Breast tenderness or enlargement
- Headaches (may be clot related so if headaches develop – consider changing birth control and contact your health care provider)
- Missed periods
- Mood changes
- Decreased sex drive (from the increase in estrogen and progestin)
- Vaginal discharge changes
- High blood pressure
- Cancer risks: Breast
- Blood clots
Natural Hormone Option
These options do not release hormones into the body. They do however, still have their own risks and potential side effects.
Lactational Amenorrhea Method (LAM) aka Breastfeeding as Birth Control
- Effectiveness: *CAN* be 98% Effective (can also suddenly not be 98% effective 😅)
- Cost: $0
- Length of coverage: Use every day (for about 6-9 months)
- How it works and other notes: Nurse every 4 hours during the day and every 6 hours at night for best results. When the body is producing this much milk, the hormones shift preventing ovulation. No period and no egg released to become pregnant. Unfortunately, breast pumps usually do not have the same result as breastfeeding a baby for this to work well. It also usually ends when your little one begins to eat other foods. My boys all started regularly eating other foods around 9 months. Almost right to the day they started was when I would get my period back.
- Some of the risks and side effects: It is nearly impossible to know when it is no longer effective until your period has arrived – which may be after you are already able to get pregnant!
Non Hormonal Options
IUD (intrauterine device)
- Effectiveness: 99%
- Cost: up to $1300
- Length of coverage: Lasts Up To 3-12 years
- How it works and other notes: IUDs release a low dose of copper into the womb. This thickens the cervix mucous lining to reduce the chance of the sperm reaching the egg. It also alters the lining of the womb to prevent the egg from implanting (meaning even a fertilized egg may be spontaneously aborted). There are 5 distinct factors that are clues to avoid a copper IUD: frequent infection, being pregnant, disruption in uterine conditions, gynecologic cancer, and adverse reactions to copper (11).
- Some of the risks and side effects:
- Periods may become longer and heavier with more cramps/pain.
- Increased risk of infections (yeast and bacterial vaginosis) – especially with longer periods.
- Although considered rare, it can damage the uterine wall even causing a hole.
- If hormone based, then added hormone imbalance concerns (including moods, weight gain, headaches, etc).
- Increased risk of ectopic pregnancy (egg is implanted outside of the womb, usually in the fallopian tubes where the egg will not be able to grow or be saved. These pregnancies are also dangerous for the mother.
- Copper will disrupt the vaginal microbiome – and potentially the gut since most of us recognize that what we put in our bodies in one spot doesn’t restrict it to only there if blood and lymph can transport it – causing frequent infections.
- anemia (low red blood cell count)
- expulsion (completely or partially pushing out the IUS)
- pain during sex
- spotting
- prolonged periods
- painful periods
- vaginal irritation
- vaginal discharge
- backache
- pain and cramping
Male Condom
- Effectiveness: 87%
- Cost: $0 to $2
- Length of coverage: Use every time
- How it works and other notes: Creates a very thin barrier over the penis preventing sperm from reaching the egg.
- Some of the risks and side effects: Thin barriers can get even tiny holes that let sperm out, or they can tear. Using oil based lubricants or some spermicides may degrade the material of the condom. Can cause irritation or infection. If allergic to latex, be careful of what ones you choose.
Female Condom
- Effectiveness: 79%
- Cost: $0 to $3
- Length of coverage: Use every time
- How it works and other notes: Creates a barrier within the cervix so sperm does not reach the egg.
- Some of the risks and side effects: These can tear or have small holes. Using oil based lubricants or some spermicides may degrade the material of the condom. Can cause irritation or infection. If allergic to latex, be careful of what ones you choose.
Diaphragm
- Effectiveness: 83%
- Cost: $0 to $75
- Length of coverage: Use every time
- How it works and other notes: Similar to the action of a female condom but without the sheathing to help prevent STDs and being reusable, diaphragms create a barrier in the cervix to stop the sperm from reaching the egg.
- Some of the risks and side effects: These can tear or have small holes. Using oil based lubricants, some spermicides, and some yeast medications may degrade the material. Can cause irritation or infection. If allergic to latex, be careful of what ones you choose. They are made with silicone or latex options.
Birth Control Sponge
- Effectiveness: 78 to 86%
- Cost: $0 to $15
- Length of coverage: Use every time
- How it works and other notes: Similar to the action of a female condom but without the sheathing to help prevent STDs, this “sponge” made of polyurethane foam is placed inside the vagina across the cervix opening. It is filled with a spermicide called nonoxynol-9 to create a physical and chemical barrier to prevent the sperm from reaching the egg. These are disposable and some cost more than others.
- Some of the risks and side effects:
- The spermicide may cause irritation that increases the risk of HIV, STDs, and infections.
- May have an allergic reaction to the polyurethane or sulfites used in the sponge.
Spermicides
- Effectiveness: 79 to 86%
- Cost: $0 to $270
- Length of coverage: Use every time
- How it works and other notes: These are mixtures of chemicals that are “gel” like. May be inserted into your vagina or condom, ring, sponge, etc. The chemical compositions vary from product to product, but the majority use Nonoxynol-9 (N-9). This decreases surface tension, destroying the sperm cell membrane.
- Some of the risks and side effects:
- Urinary Tract Infections
- Vaginal Irritation
- Allergic Reaction
- May cause irritation that increases the risk of HIV, STDs, and infections.
- Cloudy or bloody urine
- Increased frequency of urination
- Pain in lower abdomen
Cervical Cap
- Effectiveness: 71-86%
- Cost: $0 to $90
- Length of coverage: Use every time
- How it works and other notes: This is a prescription product that is designed to fit snugly across the cervix to prevent sperm from reaching the egg. Most often used in conjunction with spermicide (so reference the side effects from above as well).
- Some of the risks and side effects:
- Made of latex or silicone so choose wisely for your body
- Spermicide
- Urinary Tract Infections
- Vaginal Irritation
- Allergic Reaction
- May cause irritation that increases the risk of HIV, STDs, and infections.
- Cloudy or bloody urine
- Increased frequency of urination
- Pain in lower abdomen
Natural Family Planning/Fertility Awareness
- Effectiveness: 77-98%
- Cost: $0
- Length of coverage: Use every day
- How it works and other notes:
- A woman’s cycle lasts about 28 days (some vary down to 25 days, but most are 28). The start of the menstruation (when the blood discharge starts) is the easiest place to begin tracking.
- Apps like Flo, Spot On, or Cycles
- Manual Tracking uses a calendar to mark down your first day of a fully flowing period (not just a little spotting), then go back 14 days to mark your likely ovulation day. Mark when your flow stops (usually in a 3-7 day range). Make note of any spotting, breast tenderness, headaches, cramping, energy fluctuations, color of your flow, or mood swings. In theory, the next ovulation day will be the day following the 28th day after the previous ovulation day. It may take a few months to see a pattern.
- Some of the risks and side effects:
- Effectiveness is lower and can be hit or miss, especially if math or attention to detail is not one’s forte. The apps help with that a lot though!
- No side effects.
Withdrawal/Pull Out Method
- Effectiveness: 78%
- Cost:$0
- Length of coverage: Use every time
- How it works and other notes: When the male feels ejaculation is imminent, he pulls his penis out of the vagina.
- Some of the risks and side effects:
- Takes a lot of self control
- Lower effectiveness
- Pre-ejaculation can still occur and may be enough to reach an egg
Abstinence
- Effectiveness: 100%
- Cost: $0
- Length of coverage: Use every time
- How it works and other notes: Restrain from vaginal sex until one has decided being pregnant is right for them.
- Some of the risks and side effects:
- Very effective
- Takes a lot of self control for both parties
- No risks or side effects
Tubal Ligation
- Effectiveness: 99%
- Cost: $0 to $6000
- Length of coverage: Permanent
- How it works and other notes: The fallopian tubes are cut, tied, or otherwise blocked to prevent an egg from passing through to the uterus. The eggs will still mature, but after release in the ovaries, it is blocked and will eventually break down in the ovaries. The menstrual cycle is usually not disrupted. In most cases, this is an outpatient procedure now.
- Some of the risks and side effects:
- Damage to the bowel, bladder or major blood vessels (12)
- Heavy bleeding possible especially if there is a previous c-section or used a copper IUD (13)
- Regret after choice
- Bleeding from incisions
- Reactions to anesthesia (especially if you have MTHFR)
- “Mood swings, hot flashes, anxiety/depression, fatigue/sleep problems, and vaginal dryness” (14)
- “Pain during intercourse, aching lower back, premenstrual tension syndrome, difficulty in menstruating, uterine hemorrhage, and absence of menstruation” (15)
- Increased risk of Endometriosis (16)
- While it is generally said that tubal ligation does not affect hormones, some have found lowered progesterone levels afterwards (17)
- Increased risk of diabetes, Pelvic Inflammatory Disease, Lung Disease, and Weight gain (18)
- Ectopic pregnancy
- Uterine vascular congestion (19) (you can read more about this issue here)
- And more…
Vasectomy
- Effectiveness: 99%
- Cost: $0 to $1000
- Length of coverage: Permanent
- How it works and other notes: The tubes that deliver the sperm from the testicles into the semen are called the Vas Deferens. In a vasectomy, these are cut and tied off preventing the sperm from leaving in ejaculation (99% of the time, anyway).The sperm cannot cross over the vas deferens leaving it to be reabsorbed by the body.
- Some of the risks and side effects:
- “Hematoma formation, infection, sterilization failure, sperm granulomas, short-term postoperative pain (nodal pain, scrotal pain, and ejaculation pain), and chronic pain syndrome” (20)
- Increased risk of prostate cancer (21)(22)
- Some men experience regret, anxiety
- Chronic scrotal pain or discomfort (23)
- Reduced mortality rates (24)
- Kidney, bladder, and urethra stone formation more likely (25)
The choice is hard, but take the time to carefully weigh the risks and complications. I jumped right into the Depo-Provera shot after the provider recommended it to me. I believed her when she said the risks weren’t that bad. That it was most effective so that was more important. Nearly 20 years later, I am still struggling with out of whack hormones. I am getting a lot closer though these last couple of years thanks to improved gut health, nutrition, and a few other things I have tried. You can read my tips in 7 Ways to Naturally Balance Your Hormones.
